Provider Demographics
NPI:1972723179
Name:BLACKMON, ELLEN BARTON (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:BARTON
Last Name:BLACKMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ELLEN
Other - Middle Name:HUSTON
Other - Last Name:BARTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 678746
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8746
Mailing Address - Country:US
Mailing Address - Phone:205-824-8000
Mailing Address - Fax:205-824-8111
Practice Address - Street 1:810 ST VINCENTS DRIVE
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1601
Practice Address - Country:US
Practice Address - Phone:205-824-8000
Practice Address - Fax:205-824-8111
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL319622085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology